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discrepancy with LMP dates. Otherwise use LMP dates 2 new expanded Ballard scoring. If there is no definite estimate but baby is referred to as term baby, enter 40
13. Growth status: based on Intrauterine Growth Curves in training manual Composite Male Female chart. SGA10th centile; AGA 10-90th centile; LGA
90th centile 14. Gender: Indicate Male, Female or Indeterminate
15. Place of birth: Inborn- born in the same hospital as the participating site. If born within the wards of
the participating hospital to be considered as inborn unless in the ambulance
– born before arrival
Outborn: Born in another place includes BBA and transferred after birth to the NNU of the participating site. Includes those born in the hospital compound.
1. University Hospital 2. General Hospital
3. Private Hospital 4. District Hospital with specialist
5. District Hospital without specialist 6. Private Maternity Home
7. Home 8. Others e.g. in transit, please specify
All big city government hospitals are considered as General hospitals and ticked as 2. District hospitals with specialist pertain to availability of specialist post even if this
post is not filled. 16. Multiplicity: To indicate as singleton, twin, triplet or others i.e. quadruplets, etc.
17. Mode of delivery: Tick as relevant. Rarely more than 1 may apply. All caesarians are considered as such without differentiation into upper or lower
segment. For breech presentation in Caesarian section, tick as Caesarean section only
18. Apgar Score at 1 min and 5 min: Enter the apgar score at 1min and at 5 mins as noted in the Labour and delivery record
19. Initial resuscitation:
Tick “Yes for all intervention that apply
19a. Oxygen:
Tick “Yes” if the baby received any supplemental oxygen in the delivery room Tick “No” if the baby did not receive supplemental oxygen in the delivery room.
19b. Bag-mask vent : Tick “Yes” if the baby received any positive pressure breaths with a bag and
face mask in the delivery room. Tick “No” if the baby did not receive any positive pressure breaths with a bag
and mask in the delivery room. Tick “No” if a bag and face mask were only used to
administer CPAP continuous positive airway pressure and no positive pressure breaths were given.
19c. Endotracheal tube ventilation:
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Tick “Yes” if the baby receive ventilation through an endotracheal tube in the delivery room
Tick “No” if the baby did not received ventilation through an endotracheal tube in the delivery room.
If an endotracheal tube was placed only for suctioning and assisted ventilation was not given
through the tube, tick “No” 19d. Cardiac Compression:
Tick “Yes” if external cardiac massage was given in the delivery room Tick “No” if external cardiac massage was not given in the delivery room
19e. Adrenaline: Tick “Yes” if adrenaline was given in the delivery room via intravenous,
intracardiac or intratracheal routes. Tick “No” if adrenaline was not given in the delivery room via intravenous,
intracardiac or intratracheal routes. SECTION 3: Neonatal Event
20.Respiratory support:
Tick “Yes” for all ventilation support given. 1. Oxygen
– infant was given supplemental oxygen at any time after leaving the delivery room
2. CPAP – in the infant was given continuous positive airway pressure applied
through the nose at any time after leaving the delivery room 3. Conventional Ventilation
– is intermittent positive pressure ventilation through an endotracheal tube with a conventional ventilator IMV rate 240min at any time after
leaving the delivery room 4. High frequency oscillatory ventilation as delivered by an oscillator. High
frequency oscillatory ventilation IMV rate 240min at any time after leaving the delivery room. High frequency oscillatory ventilation via nasal prongs is not
considered HFOV 5. Nitric Oxide
– nitric oxide delivered as a gas via a ventilator at any time after leaving the delivery room
6. Others may include High Frequency Jet Ventilation HFJV or Liquid ventilation at any time after leaving the delivery room.
21. Total Duration of Ventilatory support: State to next complete day i.e. 24 hours is 1 day and 2 days 4 hours is 3 days, excluding CPAP.
22. Surfactant:
Indicate whether exogenous surfactant was given or not. If “Yes” indicate whether the infant received it at 1hr, 1 to 2 hrs. or 2hrs postnatal age.
23. Post Natal Steroid for CLD: Indicate given or not if systemic corticosteroids were used after birth to treat bronchopulmonary dysplasia or chronic lung disease
CLD. Steroids given for other purposes e.g. hypotension and laryngeal oedema will not be included. Inhaled corticosteroids are not considered systemic corticosteroids.
